open access
Echocardiographic assessment of left atrial morphology and function to predict maintenance of sinus rhythm after electrical cardioversion in patients with non-valvular persistent atrial fibrillation and normal function or mild dysfunction of left ventricle
, 12, 3, 3, 2, 32
Affiliations- Intensive Cardiac Care Unit, Swietokrzyskie Cardiology Center, Kielce, Poland, Grunwaldzka, 25-735 Kielce, Poland
- Faculty of Medicine and Health Sciences, The Jan K ochanowski University, Kielce, Poland
- Department of Cardiology and Electrotherapy, Swietokrzyskie Cardiology Center, Grunwaldzka Street 45, 25-736 Kielce, Poland
open access
Abstract
Background: The aim of this study was to assess whether echocardiographic measurements of left atrial (LA) morphology and function could predict sinus rhythm maintenance after electrical cardioversion among patients with atrial fibrillation (AF) and normal function or mild dysfunction of the left ventricle (LV).
Methods: One hundred seventeen patients with persistent AF who underwent successful electrical cardioversion were prospectively enrolled. Echocardiography was performed one day subsequent to successful cardioversion. Patients were followed up clinically and electrocardiographically at 1, 6, and 12 months. At 12 months, 61 (52%) patients had maintained sinus rhythm (SR).
Results: Compared to patients who maintained SR, those with AF recurrence had larger LAs, worse LA systolic function, and increased LV filling pressure. On multivariate stepwise logistic regression, E/A ratios (odds ratio [OR] 0.550, 95% confidence interval [CI] 0.341–0.886; p = 0.014) and E/e’ ratios (OR 0.871, 95% CI 0.771–0.985; p = 0.027) were significant predictors of AF recurrence. On receiver operator characteristic curve analysis of AF recurrence at 12 months, the area under curve for both E/A and E/e’ ratios were 0.726. With an E/A cutoff of 2.2, the sensitivity for predicting AF recurrence at 12 months was 72%, and specificity was 73%. With an E/e’ cutoff of 9.17, the sensitivity for predicting AF recurrence at 12 months was 72%, and specificity was 74%.
Conclusions: Left ventricular filling pressure assessed with E/A and E/e’ ratios predict AF recurrence after electrical cardioversions among patients with AF and normal function of LV.
Abstract
Background: The aim of this study was to assess whether echocardiographic measurements of left atrial (LA) morphology and function could predict sinus rhythm maintenance after electrical cardioversion among patients with atrial fibrillation (AF) and normal function or mild dysfunction of the left ventricle (LV).
Methods: One hundred seventeen patients with persistent AF who underwent successful electrical cardioversion were prospectively enrolled. Echocardiography was performed one day subsequent to successful cardioversion. Patients were followed up clinically and electrocardiographically at 1, 6, and 12 months. At 12 months, 61 (52%) patients had maintained sinus rhythm (SR).
Results: Compared to patients who maintained SR, those with AF recurrence had larger LAs, worse LA systolic function, and increased LV filling pressure. On multivariate stepwise logistic regression, E/A ratios (odds ratio [OR] 0.550, 95% confidence interval [CI] 0.341–0.886; p = 0.014) and E/e’ ratios (OR 0.871, 95% CI 0.771–0.985; p = 0.027) were significant predictors of AF recurrence. On receiver operator characteristic curve analysis of AF recurrence at 12 months, the area under curve for both E/A and E/e’ ratios were 0.726. With an E/A cutoff of 2.2, the sensitivity for predicting AF recurrence at 12 months was 72%, and specificity was 73%. With an E/e’ cutoff of 9.17, the sensitivity for predicting AF recurrence at 12 months was 72%, and specificity was 74%.
Conclusions: Left ventricular filling pressure assessed with E/A and E/e’ ratios predict AF recurrence after electrical cardioversions among patients with AF and normal function of LV.
Keywords
atrial fibrillation, direct current cardioversion, diastolic dysfunction
About this articleTitle
Echocardiographic assessment of left atrial morphology and function to predict maintenance of sinus rhythm after electrical cardioversion in patients with non-valvular persistent atrial fibrillation and normal function or mild dysfunction of left ventricle
Journal
Issue
Pages
246-253
Published online
2019-07-08
Page views
1349
Article views/downloads
833
DOI
Pubmed
Bibliographic record
Cardiol J 2020;27(3):246-253.
Keywords
atrial fibrillation
direct current cardioversion
diastolic dysfunction
Authors
Paweł Wałek
Janusz Sielski
Katarzyna Starzyk
Iwona Gorczyca
Joanna Roskal-Wałek
Beata Wożakowska-Kapłon
References (21)- Magnani JW, Rienstra M, Lin H, et al. Atrial fibrillation: current knowledge and future directions in epidemiology and genomics. Circulation. 2011; 124(18): 1982–1993.
- Vizzardi E, Curnis A, Latini MG, et al. Risk factors for atrial fibrillation recurrence: a literature review. J Cardiovasc Med. 2014; 15(3): 235–253.
- Goette A, Kalman J, Aguinaga L, et al. EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. Europace. 2016; 18(10): 1455–1490.
- Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016; 18(11): 1609–1678.
- Pisters R, Nieuwlaat R, Prins MH, et al. Clinical correlates of immediate success and outcome at 1-year follow-up of real-world cardioversion of atrial fibrillation: the Euro Heart Survey. Europace. 2012; 14(5): 666–674.
- Fornengo C, Antolini M, Frea S, et al. Prediction of atrial fibrillation recurrence after cardioversion in patients with left-atrial dilation. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 335–341.
- Wożakowska-Kapłon B, Bartkowiak R. Biomarkers for prognosis in atrial fibrillation: unfulfilled hopes. Pol Arch Med Wewn. 2015; 125(6): 400–401.
- Bartkowiak R, Wozakowska-Kapłon B, Janiszewska G. Plasma NT-proANP in patients with persistent atrial fibrillation who underwent successful cardioversion. Kardiol Pol. 2010; 68(1): 48–54.
- Wozakowska-Kaplon B, Bartkowiak R, Janiszewska G. A decrease in serum aldosterone level is associated with maintenance of sinus rhythm after successful cardioversion of atrial fibrillation. Pacing Clin Electrophysiol. 2010; 33(5): 561–565.
- Lang R, Badano L, Mor-Avi V, et al. Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233–271.
- Nagueh SF, Smiseth OA, et al. Appleton CP Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016; 17(12): 1321–1360.
- Strickberger SA, Ip J, Saksena S, et al. Relationship between atrial tachyarrhythmias and symptoms. Heart Rhythm. 2005; 2(2): 125–131.
- Ziegler PD, Koehler JL, Mehra R. Comparison of continuous versus intermittent monitoring of atrial arrhythmias. Heart Rhythm. 2006; 3(12): 1445–1452.
- Toufan M, Kazemi B, Molazadeh N. The significance of the left atrial volume index in prediction of atrial fibrillation recurrence after electrical cardioversion. J Cardiovasc Thorac Res. 2017; 9(1): 54–59.
- Luong CL, Thompson DJS, Gin KG, et al. Usefulness of the atrial emptying fraction to predict maintenance of sinus rhythm after direct current cardioversion for atrial fibrillation. Am J Cardiol. 2016; 118(9): 1345–1349.
- Chung H, Lee BK, Min PKi, et al. Left ventricular filling pressure as assessed by the e/e' ratio is a determinant of atrial fibrillation recurrence after cardioversion. Yonsei Med J. 2016; 57(1): 64–71.
- Wozakowska-Kapłon B, Opolski G. The dubious value of echocardiographic and plasma ANP measurements in predicting outcome of cardioversion in patients with persistent atrial fibrillation. Int J Cardiol. 2005; 103(3): 280–285.
- Caputo M, Urselli R, Capati E, et al. Usefulness of left ventricular diastolic dysfunction assessed by pulsed tissue Doppler imaging as a predictor of atrial fibrillation recurrence after successful electrical cardioversion. Am J Cardiol. 2011; 108(5): 698–704.
- Kosiuk J, Breithardt OA, Bode K, et al. The predictive value of echocardiographic parameters associated with left ventricular diastolic dysfunction on short- and long-term outcomes of catheter ablation of atrial fibrillation. Europace. 2014; 16(8): 1168–1174.
- Luong C, Thompson DJS, Bennett M, et al. Right atrial volume is superior to left atrial volume for prediction of atrial fibrillation recurrence after direct current cardioversion. Can J Cardiol. 2015; 31(1): 29–35.
- Okura H, Takada Y, Kubo T, et al. Tissue Doppler-derived index of left ventricular filling pressure, E/E', predicts survival of patients with non-valvular atrial fibrillation. Heart. 2006; 92(9): 1248–1252.
